IV Site Prep

EricTAMUCC-BSN, BSN, RN · Dec 20, 2004

What's so great about chlorehexidine?

UM Review RN, ASN, RN · Dec 20, 2004

When prepping the client's skin for venipuncture, cleanse the skin with betadine and wait for it to dry. Do not apply alcohol after the skin has been prepped with betadine. If these substances are combined, they form a toxic material that may be absorbed through the skin."
-Fundamentals of Nursing, Second Edition, pg 1112

Wow! Learn something new every day! Thanks for sharing this. I only usually use alcohol swabs, but it's nice to know more.

Antikigirl, ASN, RN · Dec 20, 2004

I have had to go with my facilities policy and that differs from facility to facility! Make sure you know these!

Now...my favorite nursing jobs have been in the field, and ETOH is the way to go..it isn't like you are going to be in a sterile enviroment tending a patient trapped in a car, or laying in the middle of a crowd at an outdoor event. But at that point it is usually a case of IV placement outweighing the risk of infections, so you do the best you can!

I had a nursing co-worker of mine chew out a paramedic one day for not using betadine...this patient was in the midst of a stroke, and there she was complaining about their technique!!!! OMGoodness I was about to strangle her as much as the paramedics were!!!!!! She had just taken a refresher course on IV's and was acting "the expert" on it..uhgggggg! She was like "no..circle from point out with betadine, then do the same with alcohol never touching a point not covered by betadine...no you are doing it wrong..let me do it"....Ummmm I would SO suggest NOT doing that!!!! Not if you have a stroke patient and seconds count!!!! Any probelms from IV starts can be solved after you save their lives!!!!!!! (she also got all angry and yelling at them for them taking her to the closest hospital instead of the patients request for another hospital that was not only on divert..but 45 minutes away!!!!!...NOPE closest ED with a cat scan wins!!!!! I almost had to physically pull her out of the room!!!!).

OH hee hee hee..just read the one above....so she was wrong anyway! LOL!

KacyLynnRN · Dec 21, 2004

We use a new chemical at our facility, called 'chloraprep' to prep the site before peripheral IV insertion. I would say I use it about 75% of the time...I will admit that sometimes I get to the bedside in a rush, don't have the stuff available without walking down the hall for a few minutes, the pt. is anxious or combative and I just have to go for it...I know I might get some flack for admitting that, but it's the truth. The rest of the time I use plain old alcohol.

dansdoll · Dec 22, 2004

I just use alcohol for PIV's

Just alcohol here too, unless the iv will be used for law enforcement blood draw or cultures then use iodine swabs

nurselisER · Dec 22, 2004

I was taught this way and any other way or reversing 1&2 was a fail on the practical and the written: 1. Alcohol wipe, starting at the center of the site moving in a circular motion outward, dry. 2. Betadine (providing there are no contras prior to starting) applied the same way 3. Allow to dry (no wiping over or start over) The latest in my neck of the woods is... the IV packets of alcohol and betadine no longer contain the betadine. Always check facility policy and procedures.

(er 911 emtprn2b) :)

*location, location, location is a "Real Estate thing"

*liability, liability, liability is a "RN thing"

bobnurse · Dec 22, 2004

In the Infusion Therapy in Clinical Practice, 2nd edition it states alcohol first then betadine. The alcohol is an instant atiseptic, but leaves no antimicrobial properties. The betadine will leave antimicrobial properties behind, preventing an infection from occuring.

chloraprep is becoming so popular due to the fact it remains active when exposed to organic compounds, such as blood, sweat, so forth. Iodine becomes inactive when exposed to those same organic compounds.

So, if you think about it, swabbing with betadine first followed by alcohol is taking away from the benefits of the betadine. Think of alcohol as a short acting and betadine as a long acting. But more and more places are going to chloraprep swabs, as they should. And no need to swab in a circular motion with chloraprep. I had a nurse educator tell me thats how its suppose to be, and i need to research it. We bet lunch on it, (On the Border Fajitias were so good.) Go to the chloraprep site, and it cleary states under administration gudielines to scrub back and forth for 30-60 seconds with friction and allow to air dry. The alcohol kills the bacteria instantly, and the chlorhexadine leaves the properties to contine to disrupt microbial growth.

bobnurse · Dec 22, 2004

By the way, the book I referenced to is by the Infusion Nurses Society. From what im told, if you go to court for an IV related lawsuit, those are the guidlines that are used, besides your hospital policies and state boards.

kwalker5 · Dec 22, 2004

my hospital uses chlorhexidine.

RUnotentertained · Dec 22, 2004

Actually this is my first post, but I wanted to share the Guidelines for the Prevention of Intravascular Catheter-Related Infections from August 9, 2002 from the MMWR (Morbidity and Mortality Weekly Report) from the CDC (Center for Disease Control and Prevention).

Anyway, since that time due to the research that has been done in blood bourne infections from IV's (both central and peripheral lines), the recommendations have been for 2% solution of chlorhexidine for skin preparation for IV's. Chloraprep is an example of that. Alcohol and then betadine should only be used in the case of chlorhexidine allergy (a lot rarer than betadine allergy). So, if your clinic or facility is behind the times and has not switched to chlorhexidine 2% solution for skin preparation for IV access you should talk to your education department or rep who supplies your site prep. and make the switch to chlorhexidine or you are doing a possible disservice to your patients by perhaps putting them at greater risk for bacteremia since there is a lower infection rate with the use of 2% chlorhexidine.

Many nursing references are behind the time (such as the last Lippincott which was published before the CDC Guidelines).

Skin cleansing is done with a back and forth motion unlike the circular motion used for betadine. It takes about 30 seconds for the site to dry (faster than betadine and slower than alcohol, but only one agent to use).

Here's the CDC site link. Good mountain of information on various health issues: http://www.cdc.gov/mmwr/index.html

Thanks, Marie.

BTW, I am an educator that went through changing all our IV prep out from alcohol and betadine to chlorhexidine prep as well as our P & P's at our hospital.

Here's the direct link to the findings: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

CRNAsoon · Dec 22, 2004

Thanks for sharing. Great information!

Actually this is my first post, but I wanted to share the Guidelines for the Prevention of Intravascular Catheter-Related Infections from August 9, 2002 from the MMWR (Morbidity and Mortality Weekly Report) from the CDC (Center for Disease Control and Prevention).
Anyway, since that time due to the research that has been done in blood bourne infections from IV's (both central and peripheral lines), the recommendations have been for 2% solution of chlorhexidine for skin preparation for IV's. Chloraprep is an example of that. Alcohol and then betadine should only be used in the case of chlorhexidine allergy (a lot rarer than betadine allergy). So, if your clinic or facility is behind the times and has not switched to chlorhexidine 2% solution for skin preparation for IV access you should talk to your education department or rep who supplies your site prep. and make the switch to chlorhexidine or you are doing a possible disservice to your patients by perhaps putting them at greater risk for bacteremia since there is a lower infection rate with the use of 2% chlorhexidine.
Many nursing references are behind the time (such as the last Lippincott which was published before the CDC Guidelines).
Skin cleansing is done with a back and forth motion unlike the circular motion used for betadine. It takes about 30 seconds for the site to dry (faster than betadine and slower than alcohol, but only one agent to use).
Here's the CDC site link. Good mountain of information on various health issues: http://www.cdc.gov/mmwr/index.html
Thanks, Marie.
BTW, I am an educator that went through changing all our IV prep out from alcohol and betadine to chlorhexidine prep as well as our P & P's at our hospital.
Here's the direct link to the findings: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm

nurselisER · Dec 23, 2004

The chloraprep did replace the beta/alcohol prep kits here. This is a hot topic and a serious one. I once overheard another medic saying why bother to prep the IV site during a cardiac arrest because..."he's already dead"

(bbl)